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Junior Anaesthesia > Monitoring in Anaesthesia > Flashcards

Monitoring in Anaesthesia Flashcards

1
Q

Monitoring

Types:
List them

A

Continuous
Continual
Non-invasive
Invasive

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2
Q

Monitoring

Types:
• Continuous – __________________
 Continual – __________________
• Non-invasive
Invasive

A

without any interruption

repeated at regular intervals

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3
Q

Standard for Basic Intra-operative Monitoring:
•Presence of ________________ throughout the procedure
•Evaluation of –
________,________,_______,________
•__________ & _________ monitoring

A

qualified anaesthetic personnel

Oxygenation
Ventilation
Circulation
Body temp

Clinical & Equipment

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4
Q

Resp Sys monitoring
Clinical
•Colour – _______
•Movement of _________
•Signs of __________
•Signs of __________
•Chest ________
•Chest ________

A

cyanosis

reservoir bag

obstruction; CO2 retention

excursion; auscultation

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5
Q

PULSE OXIMETER

• (Invasive or Non-invasive?) measurement of ________ in ________ blood. Also measures ________

• Differential wavelengths of _____ (______nm) and ________ (_______nm) light absorbed by ________-Hb & _____-Hb respectively.

A

Non-invasive ; O2 saturation

arterial; pulse rate

Red ; 660nm ; Infra- red ; 940nm

deoxy-Hb ; Oxy-Hb

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6
Q

Pulse oximeter

_____ emits light detected by ___________

A

LED

photo-detector diode

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7
Q

Pulse oximeter

The presence of well oxygenated blood → ↑ absorbtion of ______ light
• The presence of more de-oxygenated blood e.g. from difficult intubation, oesophageal intubation will absorb more _____ light

• The ______ calculates what is absorbed and produces a value for SpO2

A

IRed; Red

PDC

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8
Q

Pulse oximeter

During _______ blood is pumped into finger →↑ volume of finger demonstrated by the height of the ____________

A

Systole

plethysmograph

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9
Q

The pulse oximeter

Displays the ________ and ————- of the blood
•A probe is placed top to bottom over a digit from which light is emitted, absorbed and detected.
•May be inaccurate in some situations

A

pulse rate and oxygen saturation

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10
Q

Pulse oximeter

Pulse amplitude gives an indication of _____________

A

tissue perfusion

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11
Q

Accuracy of pulse oximeter affected by :

•____Hb (false ↑), ____Hb
•Position – _____,______,_______,_________
•Peripheral vaso_________
•Excess _________
•_______
• ______________
•↓↓ ______ states – hypotension, anaemia, hypothermia
•________ pulsation

A

Co; met

earlobe, bridge of nose, finger, toe

constriction; ambient light

Dyes; Coloured nail polish

perf; Venous

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12
Q

Pulse oximeter

Problems:
•Monitors ____________ but provides no direct info about ____________
•Response time of ____________.
•Cannot detect acute ______________.
•_______ or ____________ especially with long application on same site >______ in children.

A

O2 saturation ; O2 delivery

10 – 20 secs.

acute desaturation.

Burns or pressure sores

> 2 hrs

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13
Q

OXYGEN ANALYSER
•Essential to monitor __________ in gas mixture

A

FiO2

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14
Q

CAPNOGRAPHY
•Measures ________________ .
•Assesses ________________ of ventilation.
•Uses the principle of _______________

A

expired CO2 concentration.

adequacy

Absorbtion spectrometry

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15
Q

Capnography

principle of Absorbtion spectrometry –
 Molecules with ___________________ will _____________ .

A

2 dissimilar atoms

absorb IR light.

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16
Q

Types of sampling

 ____stream
 ____stream

A

Main

Side

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17
Q

Clinical Considerations of capnography :

•Assesses __________ of ventilation
•Allows ventilation to be ________
•Measures __________
•Reliably identifies ___________________.
•Does not reliably detect ________________

A

adequacy ;modified

respiratory rate

oesophageal intubation.

endobronchial intubation

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18
Q

ETCO2

A

End tidal CO2

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19
Q

Normal ETCO2 = ???

A

3.5 – 5.7 kPa

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20
Q

Capnography

Phases of

Exp I – __________ gas
II – _______________________ gas
III – _________ gas
IV – _________

A

Phases of Exp I – Dead space gas
II – Dead space gas + alveolar gas
III – Alveolar gas
IV – Inspiration

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21
Q

Factors that increase ETCO2

•_________
•_____ventilation
•_______
•___________________
•_______ storm

A

ETCO2
•Rebreathing
•Hypoventilation
•Sepsis
•Malignant hyperthermia
•Thyroid storm

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22
Q

Factors that decrease ETCO2

____________
•____________
•____________
•_________ventilation
•________perfusion
•______thermia
•_______metabolism

A

Disconnection
•Cardiac arrest
•Pulm Embolism
•Hyperventilation
•Hypoperfusion
•Hypothermia
•Hypometabolism

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23
Q

Capnography tracings

____________-Elevated baseline FiCO2 is high – 1.6kPa

A

Rebreathing

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24
Q

Capnography tracings

•In rebreathing, ______ will be high – exhaustion of ______, ______ fresh gas

•In COAD – slow rising of ________, ________ is peaked

•In Recovery from NMB – patient gains ____________ and attempts __________ (___________)

A

FiCO2 ; soda lime

low ; Phase II, Phase III

spontaneous ability ;take a breath

curare cleft

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25
Q

Sudden precipitous fall in ETCO2 with ________ and _______

No ETCO2 with ______________

A

cardiac arrest disconnection

oesophageal intubation

26
Q

O2 Failure warning device :
• _________ alarm of at least _____ decibels •Powered by _________ only.
•Cuts off _________ supply
•Open circuits to _________.
•Cannot be _________ or _________ until _________ is restored

A

Auditory ; 60 ; O2 pressure

anaesthesia gas ; atmospheric air.

switched off ; O2 supply

27
Q

PRECORDIAL STETHOSCOPE

• Placed over the ______ side of the ______

•Confirms position of ______
 Confirms ______ of ______
 Assesses quality of __________
 Assesses quality of ___________
 Assesses ______ & ______
• Essential for ______ pts.

A

left ; chest

ETT ; adequacy of ventilation

breath sounds; heart sounds

HR & rhythm

paediatric pts.

28
Q

Oesophageal stethoscope

Can incorporate –
•__________________
• __________
•______________

A

Temp probe (core temp)

ECG leads

Atrial pacemaker

29
Q

Oesophageal stethoscope

Contraindicated in – _____________ or ____________
•Only used in ___________ patients.

A

oesophageal varices or stricture.

intubated

30
Q

Cardiovascular System
•Clinical
 ________
 __________
 _____________
 ______________

A

Pulse
Heart sounds
Extremities
Urine output.

31
Q

Cardiovascular System
•Clinical
 Pulse – ____,______,_________
 Heart sounds –_____,_________ esp in paeds
 Extremities – warm, dry & pink, capillary refill
 Urine output.

A

rate, rhythm, volume

rate, intensity

32
Q

ELECTROCARDIOGRAM
•Monitors ____________ of the heart.
•Does not give any indication of ______

A

electrical activity ; CO

33
Q

Electrocardiogram

•Uses
 Determine _________
 Diagnosis of ________, ________ conduction defect
Diagnosis of __________ _______

A

heart rate

ischaemia, arrhythmias

electrolyte imbalance

34
Q

Electrocardiogram

_____ or _____ Lead configuration
 Lead II – best detects _________
 Lead I – best detects __________

A

3 or 5

arrhythmias

ischaemia

35
Q

Electrocardiogram Inaccuracies :

•_____________ electrodes – should be over
________________.
•_________ contact – conductive gel b/w skin & electrode.
•Muscular activity e.g __________ , ↑ tone •____________ interference e.g ____\___
•Improper placement of ________________

A

electrodes ; bony prominences.

Poor skin; shivering

Electromagnetic interference ; diathermy

diathermy pads

36
Q

ARTERIAL BLOOD PRESSURE
•Pulsatile arterial pressure due to rhythmic ventricular contraction.
•Reflects organ blood flow.
 Sys BP
 Diast BP
 Pulse pressure = _______ -_______
 MAP = ___________

A

SBP – DBP

MAP = DBP + 1/3 PP

37
Q

Non-invasive Blood Pressure
• Relative C/I – site of ___________

A

vascular shunts

38
Q

Non-invasive Blood Pressure

• Pneumatic cuff
• Palpable artery – usually ________
• Hg manometer/ aneroid gauge to display cuff press
__________________ – used in electronic devices
• Must be measured at least ______________

A

brachial

Oscillotonometry

every 5 minutes

39
Q

Pneumatic cuff
 Different cuff sizes- adult to neonatal (12cm std adult)
 Occupy _____ of upper arm
 Width of bladder –___________% > ———— of arm
________ of bladder over brachial artery

A

2/3

20- 50; diameter

Mid-point

40
Q

Methods of detection of arterial blood pressure :
•__________ – no DBP or MAP.
•___________– of ________ sounds.
•__________
•_______________

A

Palpation

Auscultation; Korotkoff

Oscillotonometry

Plethysmography

41
Q

Inaccuracies of arterial blood pressure :

•Over-reads BP with a _______ cuff, under- reads with _______ cuff.

•Atrial fibrillation and other arrhythmias
•Palpation difficult in _______ pts.
•Korotkoff sounds difficult to hear in _______ or peripheral vaso _______

A

small cuff ; large cuff

Obese

hypotension ; vasoconstriction

42
Q

Invasive Arterial pressure

•_____________ in artery to provide beat-to-beat arterial press monitoring.

A

Catheter

43
Q

Invasive arterial blood pressure

•Indications –
 __________ hypotension
 __________________ BP swings
 _____________ disease
 Need for _______ arterial blood gas sampling

A

Elective ; Large intra-op BP

End-organ; multiple

44
Q

Invasive Blood Pressure

•Risk of arterial _________
• _______ Test is done to test adequacy of ________ collaterals

A

thrombosis

Allens; ulnar

45
Q

Sites of Invasive blood pressure

 _________ art.
 _________ art.
 _________ art.
 ________________

A

Sites
 Radial art.
 Brachial art.
 Femoral art.
 Dorsalis pedis

46
Q

Complications of invasive blood pressure

 ____________
 __________ / __________
 __________, skin necrosis
 ________ damage
 Inadvertent __________

A

•Complications –
 Haematoma
 Thrombosis / embolism
 Infection, skin necrosis
 Nerve damage
 Inadvertent drug inject

47
Q

CENTRAL VENOUS PRESSURE
•Cannulation of vein in ________ to
measure filling pressure of the _________.
•Reflects Blood volume (________), _____ heart function

A

thorax ; Rt atrium.

preload

right

48
Q

CENTRAL VENOUS PRESSURE

•Indications-
 Fluid mx in __________
_______ access
 Infusion of ______ drugs
______________________
_________ of air embolism

A

hypovolemia

Venous; caustic

Total Parenteral Nutrition

Aspiration

49
Q

Sites of Central venous Cannulation

Mention 4

A

Int Jugular
Subclavian
Femoral
Basilic

50
Q

Central venous pressure

Measuring device:
_______________ (cmH2O)
_________________ (mmHg)

•Procedure
 Aseptic.
 Reqs _____ monitoring
•Normal value ___-____cmH2O

A

Water manometer

Pressure transducer

ECG

  • 0 – 8
51
Q

Urine Output
• _________ , _________ surgeries or if _________________ is anticipated
• Requires a urinary catheter
• Aim for ____ml/kg/hr
• Must be measured every _________
• Check that catheter is not _________ or _________

A

Major ; prolonged

significant blood loss is anticipated

1; hour

kinked or misplaced

52
Q

Central Nervous System
DEPTH OF ANAESTHESIA
•Clinical
_______ stages of anaesthesia
 Sympathetic stim – ___,_____,______,_______

A

Guedels

HR, BP, sweating, lacrimation

53
Q

BiSpectral Index (BIS )
• to measure _____________________

• Combines _____________ and ______________ technology
• Electrodes transmit to the monitor

A

Depth of Anaesthesia monitor

Electro encephalography and Electromyography

54
Q

Neuromuscular Junction
• Peripheral Nerve Stimulator
 Assess ________ , ________, ________ or ________ response to electrical stimulus.

 Use ________, ________ or ________ nerve
• Train of ________

A

visual, tactile, mechanical or EMG

ulnar, facial or tibial nerve

Four

55
Q

Temperature
• ____________
•__________________thermometer

A

•Thermistor
•Infrared tympanic thermometer

56
Q

Temperature

•Peripheral Skin temp – _________
•Core temp – _________, _________, _________, _________, _________, _________ (unreliable)

A

Peripheral Skin temp – axilla
•Core temp – lower oesophagus, tympanic membrane, nasopharynx, bladder, pulmonary
artery, rectum (unreliable)

57
Q

Thermistor – incorporated into _______________, _______________

A

oesophageal stethoscope

Pulmonary artery catheter

58
Q

BLOOD LOSS
•Clinical
 Degree of pallor – _____________
___,_____,_________
 ____________

•Gravimetric
 Blood in ________
________ of swabs – ____g = ___ ml.

A

mucous membrane

HR, BP, capillary refill

Urine output

suction bottles; Weighing

1;1

59
Q

BLOOD LOSS MEAUSREMENT

MENTION 5

A

Clinical
Gravimetric
Colorimetric
Visual estimate
POC

60
Q

BLOOD LOSS

Visual Estimate
 ___________ , surgical ___________, ___________, ___________

•Colorimetric
 Measures ___________ in washed swabs &
drapes
Must know patient’s ___________
Can only be done at the ___________ of surgery

A

Suction bottles, surgical gauze, drapes, floor

Hb concentration ; pre-op Hb

end

61
Q

Haemoglobinometer

A ________ device (portable device) that determines _______ at the bedside using a drop of blood.

A

point-of-care

haemoglobin

62
Q

Essential Intra-operative monitoring

•Continuous presence of the ____________ .
•____________
•Continuous ____________
•Continuous ____________
•____________ alarm (if ____________ vent) •Continuous ____________
•BP at least every _________

A

anaesthetist.

O2 analyser; Pulse oximetry

Capnography ; Disconnection

mechanical ;ECG

5 mins

Junior Anaesthesia (16 decks)

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